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<div class="BoxDealHotBottom ViDeal">
  <div class="Title">
    <h2 class="Num2">Đăng ký</h2>
  </div>
  <div class="ViDealContent">
    <form class="frmGiaoHang js-register-form" id="UserRegisterForm" method="post" action="DangKi">
      <fieldset style="display:none;">
        <input type="hidden" name="_method" value="POST" />
        <input type="hidden" name="data[_Token][key]" value="74ccaa72ae040cfef682d227b6108b00411ac34b" id="Token2029241010" />
      </fieldset>
      <div class="ThongTinCaNhan">
        <ul class="GoiHang">
          <li>
            <p>
              <label class="Reg Reginput" for="username"><span>*</span>Tên đăng nhập</label>
              <input name="data[User][username]" type="text" id="zingdeal-register-username" maxlength="32" value="" />
              <a href="#this" title="Kiểm tra" class="Check JsCheckZingIDAccount">Check</a> <span class="Note hide">&nbsp;</span> </p>
            <div class="MuiTenDangKy">Chiều dài từ 6-32 ký tự, không gõ tiếng Việt có dấu</div>
            <div class="MuiTenDangKy" id="zingdeal-error-username-duplicate" style="display:none;">Tên đăng nhập đã tồn tại</div>
          </li>
          <li>
            <p>
              <label class="Reg Reginput" for="passwd"><span>*</span>Mật khẩu</label>
              <input type="password" name="data[User][passwd]" maxlength="32" class="JsPassword" value="" id="UserPasswd" />
            </p>
            <!--Mức độ bảo mật của pass-->
            <div class="stronglevel">
              <div id="meta1" class="meter"></div>
              <div id="meta2" class="meter"></div>
              <div id="meta3" class="meter"></div>
              <div id="meta4" class="meter"></div>
            </div>
          </li>
          <li>
            <p>
              <label class="Reg Reginput" for="confirm_password"><span>*</span>Xác nhận mật khẩu</label>
              <input type="password" name="data[User][confirm_password]" maxlength="32" class="JsConfirmPassword" value="" id="UserConfirmPassword" />
              <span class="Note hide" style="width:500px;">Trường mật khẩu mới và mật khẩu xác nhận phải giống nhau. Xin vui lòng thử lại.</span> </p>
          </li>
          <li>
            <p>
              <label class="Reg Reginput" for="phonenumber"><span>*</span>Số di động</label>
              <input name="data[UserProfile][phonenumber]" type="text" maxlength="12" class="JsPhone" value="" id="UserProfilePhonenumber" />
              <span class="Note hide">Số điện thoại không hợp lệ.</span> </p>
          </li>
          <li>
            <p>
              <label class="Reg Reginput" for="email">Email</label>
              <input name="data[User][email]" type="text" class="JsEmail" maxlength="255" value="" id="UserEmail" />
              <span class="Note empty hide">Phải là một email hợp lệ</span> </p>
          </li>
        </ul>
      </div>
      <h6>&nbsp;</h6>
      <div class="ThongTinCaNhan">
        <ul class="GoiHang">
          <li>
            <p>
              <label class="Reg Reginput" for="last_name">Họ</label>
              <input name="data[UserProfile][last_name]" type="text" maxlength="100" value="" id="UserProfileLastName" />
            </p>
          </li>
          <li>
            <p>
              <label class="Reg Reginput" for="middle_name">Tên đệm</label>
              <input name="data[UserProfile][middle_name]" type="text" maxlength="100" value="" id="UserProfileMiddleName" />
            </p>
          </li>
          <li>
            <p>
              <label class="Reg Reginput" for="first_name">Tên</label>
              <input name="data[UserProfile][first_name]" type="text" maxlength="100" value="" id="UserProfileFirstName" />
            </p>
          </li>
          <li>
            <p>
              <label class="Reg Reginput" for="gender_id">Giới Tính</label>
            </p>
            <div class="input select">
              <select name="data[UserProfile][gender_id]" id="UserProfileGenderId">
                <option value="">Hãy lựa chọn</option>
                <option value="0">Nữ</option>
                <option value="1">Nam</option>
              </select>
            </div>
            </p>
          </li>
          <li>
            <p>
              <label class="Reg Reginput" for="dob">Ngày sinh</label>
              <input type="text" name="dob_text" class="date JsDateTime" readonly="readonly" />
              <span class="JsDateTimeHide hide">
                <select name="data[UserProfile][dob][day]" id="UserProfileDobDay">
                  <option value="01">1</option>
                  <option value="02">2</option>
                  <option value="03">3</option>
                  <option value="04">4</option>
                  <option value="05">5</option>
                  <option value="06">6</option>
                  <option value="07">7</option>
                  <option value="08">8</option>
                  <option value="09">9</option>
                  <option value="10">10</option>
                  <option value="11">11</option>
                  <option value="12">12</option>
                  <option value="13">13</option>
                  <option value="14">14</option>
                  <option value="15">15</option>
                  <option value="16">16</option>
                  <option value="17">17</option>
                  <option value="18">18</option>
                  <option value="19">19</option>
                  <option value="20">20</option>
                  <option value="21">21</option>
                  <option value="22">22</option>
                  <option value="23">23</option>
                  <option value="24">24</option>
                  <option value="25">25</option>
                  <option value="26">26</option>
                  <option value="27">27</option>
                  <option value="28">28</option>
                  <option value="29">29</option>
                  <option value="30" selected="selected">30</option>
                  <option value="31">31</option>
                </select>
                -
                <select name="data[UserProfile][dob][month]" id="UserProfileDobMonth">
                  <option value="01">01</option>
                  <option value="02">02</option>
                  <option value="03">03</option>
                  <option value="04">04</option>
                  <option value="05">05</option>
                  <option value="06">06</option>
                  <option value="07">07</option>
                  <option value="08">08</option>
                  <option value="09" selected="selected">09</option>
                  <option value="10">10</option>
                  <option value="11">11</option>
                  <option value="12">12</option>
                </select>
                -
                <select name="data[UserProfile][dob][year]" id="UserProfileDobYear">
                  <option value="1911">1911</option>
                  <option value="1912">1912</option>
                  <option value="1913">1913</option>
                  <option value="1914">1914</option>
                  <option value="1915">1915</option>
                  <option value="1916">1916</option>
                  <option value="1917">1917</option>
                  <option value="1918">1918</option>
                  <option value="1919">1919</option>
                  <option value="1920">1920</option>
                  <option value="1921">1921</option>
                  <option value="1922">1922</option>
                  <option value="1923">1923</option>
                  <option value="1924">1924</option>
                  <option value="1925">1925</option>
                  <option value="1926">1926</option>
                  <option value="1927">1927</option>
                  <option value="1928">1928</option>
                  <option value="1929">1929</option>
                  <option value="1930">1930</option>
                  <option value="1931">1931</option>
                  <option value="1932">1932</option>
                  <option value="1933">1933</option>
                  <option value="1934">1934</option>
                  <option value="1935">1935</option>
                  <option value="1936">1936</option>
                  <option value="1937">1937</option>
                  <option value="1938">1938</option>
                  <option value="1939">1939</option>
                  <option value="1940">1940</option>
                  <option value="1941">1941</option>
                  <option value="1942">1942</option>
                  <option value="1943">1943</option>
                  <option value="1944">1944</option>
                  <option value="1945">1945</option>
                  <option value="1946">1946</option>
                  <option value="1947">1947</option>
                  <option value="1948">1948</option>
                  <option value="1949">1949</option>
                  <option value="1950">1950</option>
                  <option value="1951">1951</option>
                  <option value="1952">1952</option>
                  <option value="1953">1953</option>
                  <option value="1954">1954</option>
                  <option value="1955">1955</option>
                  <option value="1956">1956</option>
                  <option value="1957">1957</option>
                  <option value="1958">1958</option>
                  <option value="1959">1959</option>
                  <option value="1960">1960</option>
                  <option value="1961">1961</option>
                  <option value="1962">1962</option>
                  <option value="1963">1963</option>
                  <option value="1964">1964</option>
                  <option value="1965">1965</option>
                  <option value="1966">1966</option>
                  <option value="1967">1967</option>
                  <option value="1968">1968</option>
                  <option value="1969">1969</option>
                  <option value="1970">1970</option>
                  <option value="1971">1971</option>
                  <option value="1972">1972</option>
                  <option value="1973">1973</option>
                  <option value="1974">1974</option>
                  <option value="1975">1975</option>
                  <option value="1976">1976</option>
                  <option value="1977">1977</option>
                  <option value="1978">1978</option>
                  <option value="1979">1979</option>
                  <option value="1980">1980</option>
                  <option value="1981">1981</option>
                  <option value="1982">1982</option>
                  <option value="1983">1983</option>
                  <option value="1984">1984</option>
                  <option value="1985">1985</option>
                  <option value="1986">1986</option>
                  <option value="1987">1987</option>
                  <option value="1988">1988</option>
                  <option value="1989">1989</option>
                  <option value="1990">1990</option>
                  <option value="1991">1991</option>
                  <option value="1992">1992</option>
                  <option value="1993">1993</option>
                  <option value="1994">1994</option>
                  <option value="1995">1995</option>
                  <option value="1996">1996</option>
                  <option value="1997">1997</option>
                  <option value="1998">1998</option>
                  <option value="1999">1999</option>
                  <option value="2000">2000</option>
                  <option value="2001">2001</option>
                  <option value="2002">2002</option>
                  <option value="2003">2003</option>
                  <option value="2004">2004</option>
                  <option value="2005">2005</option>
                  <option value="2006">2006</option>
                  <option value="2007">2007</option>
                  <option value="2008">2008</option>
                  <option value="2009">2009</option>
                  <option value="2010">2010</option>
                  <option value="2011" selected="selected">2011</option>
                </select>
              </span> </p>
          </li>
          <li>
            <p>
              <label class="Reg Reginput" for="address">Địa chỉ</label>
              <input name="data[UserProfile][address]" type="text" maxlength="500" value="" id="UserProfileAddress" />
            </p>
          </li>
          <li>
            <p>
              <label class="Reg Reginput" for="city_id">Thành phố</label>
            </p>
            <div class="input select">
              <select name="data[UserProfile][city_id]" id="UserProfileCityId">
                <option value="Hà Giang">Hà Giang</option>
                <option value="Cao Bằng">Cao Bằng</option>
                <option value="Lai Châu">Lai Châu</option>
                <option value="Lào Cai">Lào Cai</option>
                <option value="Tuyên Quang">Tuyên Quang</option>
                <option value="Bắc Cạn">Bắc Cạn</option>
                <option value="Thái Nguyên">Thái Nguyên</option>
                <option value="Yên Bái">Yên Bái</option>
                <option value="Sơn La">Sơn La</option>
                <option value="Phú Thọ">Phú Thọ</option>
                <option value="Vĩnh Phúc">Vĩnh Phúc</option>
                <option value="Bắc Cạn">Bắc Cạn</option>
                <option value="Bắc Ninh">Bắc Ninh</option>
                <option value="Hà Tây">Hà Tây</option>
                <option value="Hải Dương">Hải Dương</option>
                <option value="Hưng Yên">Hưng Yên</option>
                <option value="Hòa Bình">Hòa Bình</option>
                <option value="Hà Nam">Hà Nam</option>
                <option value="Nam Định">Nam Định</option>
                <option value="Thái Bình">Thái Bình</option>
                <option value="Ninh Bình">Ninh Bình</option>
                <option value="Quảng Bình">Quảng Bình</option>
                <option value="Quảng Trị">Quảng Trị</option>
                <option value="Thừa Thiên Huế">Thừa Thiên Huế</option>
                <option value="Quảng Ngãi">Quảng Ngãi</option>
                <option value="Phú Yên">Phú Yên</option>
                <option value="Tây Ninh">Tây Ninh</option>
                <option value="Bình Thuận">Bình Thuận</option>
                <option value="Đồng Nai">Đồng Nai</option>
                <option value="Cần Thơ">Cần Thơ</option>
                <option value="An Giang">An Giang</option>
                <option value="Bình Định">Bình Định</option>
                <option value="Bình Dương">Bình Dương</option>
                <option value="Bạc Liêu">Bạc Liêu</option>
                <option value="Bình Phước">Bình Phước</option>
                <option value="Bến Tre">Bến Tre</option>
                <option value="Bà Rịa Vũng Tàu">Bà Rịa Vũng Tàu</option>
                <option value="Cà Mau">Cà Mau</option>
                <option value="Đăk Lăk">Đăk Lăk</option>
                <option value="Đà Nẵng">Đà Nẵng</option>
                <option value="Đồng Tháp">Đồng Tháp</option>
                <option value="Gia Lai">Gia Lai</option>
                <option value="Hà Nội">Hà Nội</option>
                <option value="TP Hồ Chí Minh" selected="selected">TP Hồ Chí Minh</option>
                <option value="Hải Phòng">Hải Phòng</option>
                <option value="Hà Tĩnh">Hà Tĩnh</option>
                <option value="Kiên Giang">Kiên Giang</option>
                <option value="Khánh Hòa">Khánh Hòa</option>
                <option value="KonTum">KonTum</option>
                <option value="Long An">Long An</option>
                <option value="Lâm Đồng">Lâm Đồng</option>
                <option value="Lạng Sơn">Lạng Sơn</option>
                <option value="Nghệ An">Nghệ An</option>
                <option value="Ninh Thuận">Ninh Thuận</option>
                <option value="Quảng Nam">Quảng Nam</option>
                <option value="Quảng Ninh">Quảng Ninh</option>
                <option value="Sóc Trăng">Sóc Trăng</option>
                <option value="Tiền Giang">Tiền Giang</option>
                <option value="Thanh Hóa">Thanh Hóa</option>
                <option value="Trà Vinh">Trà Vinh</option>
                <option value="Vĩnh Long">Vĩnh Long</option>
                <option value="Hà Đông">Hà Đông</option>
                <option value="Điện Biên">Điện Biên</option>
              </select>
            </div>
            </p>
          </li>
          <li>
            <p>
              <label class="Reg Reginput" for="marriage">Tình trạng hôn nhân</label>
            </p>
            <div class="input select">
              <select name="data[UserProfile][marriage]" id="UserProfileMarriage">
                <option value="">Hãy lựa chọn</option>
                <option value="Đã kết hôn">Đã kết hôn</option>
                <option value="Chưa kết hôn">Chưa kết hôn</option>
              </select>
            </div>
            </p>
          </li>
          <li>
            <p class="js-captcha-container">
              <label class="Reg Reginput" for="marriage"> </label>
              <span class="captcha-left"> <img src="http://deal.zing.vn/tp-ho-chi-minh/users/show_captcha/138ce5641a516eb21ff3c7427b7f7b5e" alt="[Hình: CAPTCHA hình ảnh. Bạn sẽ cần phải nhận ra những từ trong đó; âm thanh CAPTCHA cũng có sẵn.]" title="Hình CAPTCHA" class="captchI" /></span> <span class="captcha-right"> <a class="js-captcha-reload captcha-reload" title="Reload CAPTCHA" href="Untitled-2.html" >Reload CAPTCHA</a></span> </p>
          </li>
          <li>
            <p>
              <label class="Reg Reginput" for="captcha"><span>*</span>Mã bảo mật</label>
              <input name="data[User][captcha]" type="text" class="JsEmpty" value="" id="UserCaptcha" />
              <span class="Note hide" style="width:160px;">Xin vui lòng nhập captcha hợp lệ</span> </p>
          </li>
          <li>
            <p>
              <label class="Reg Reginput" for="address">&nbsp;</label>
              <input type="hidden" name="data[User][is_agree_terms_conditions]" id="UserIsAgreeTermsConditions_" value="0" />
              <input type="checkbox" name="data[User][is_agree_terms_conditions]" class="checkbox" checked="checked" value="1" id="UserIsAgreeTermsConditions" />
              <span style="color:#ff0000;">*</span>Tôi đã đọc, hiểu và đồng ý với <a href="/Pages/DieuKhoan.jsp" target="_blank">Điều khoản &amp; Chính sách</a> <span class="Note hide">Vui lòng nhập thông tin chính xác</span> </p>
          </li>
          <li class="hide">
            <p>
              <input type="hidden" name="data[User][referred_by_user_id]" value="" id="UserReferredByUserId" />
              <input type="hidden" name="data[User][type]" value="" id="UserType" />
              <input type="hidden" name="data[User][country_iso_code]" id="country_iso_code" value="" />
              <input type="hidden" name="data[State][name]" value="" id="StateName" />
              <input type="hidden" name="data[City][name]" value="" id="CityName" />
              <input type="hidden" name="data[User][referer_name]" value="" id="UserRefererName" />
            </p>
          </li>
          <li>
            <p>&nbsp;</p>
            <div class="submit">
              <input type="submit" id="zingdeal-register-submit-click" class="BtnGui SendBtn" value=" " />
              
            </div>
            <a href="#this" class="LinkKhac" title="Hủy">Hủy</a>
            </p>
          </li>
        </ul>
      </div>
      <!-- Marketing Repost -->
      <input type="hidden" name="data[User][ProductID]" value="" id="UserProductID" />
      <input type="hidden" name="data[User][TypeID]" value="" id="UserTypeID" />
      <input type="hidden" name="data[User][PromotionID]" value="" id="UserPromotionID" />
      <input type="hidden" name="data[User][BannerID]" value="" id="UserBannerID" />
      <!-- Marketing Repost -->
      <fieldset style="display:none;">
        <input type="hidden" name="data[_Token][fields]" value="2bda6f6d4b3f1c4f24474e9d1d7c7da69328b216%3An%3A4%3A%7Bv%3A0%3Bf%3A13%3A%22Hfre.OnaareVQ%22%3Bv%3A1%3Bf%3A14%3A%22Hfre.CebqhpgVQ%22%3Bv%3A2%3Bf%3A16%3A%22Hfre.CebzbgvbaVQ%22%3Bv%3A3%3Bf%3A11%3A%22Hfre.GlcrVQ%22%3B%7D" id="TokenFields882436509" />
      </fieldset>
    </form>
  </div>
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